Publications by authors named "Mireia Puig Campmany"

13 Publications

  • Page 1 of 1

The usefulness of measuring the anion gap in diagnosing metformin-associated lactic acidosis: a case series.

J Med Case Rep 2021 Jan 21;15(1):17. Epub 2021 Jan 21.

Pharmacy Department, Hospital Santa Creu i Sant Pau, C/San Quintín 89, 08041, Barcelona, Spain.

Background: Metformin-associated lactic acidosis (MALA) is a widely documented adverse event of metformin. Despite being considered one of the main causes of metabolic acidosis, the association between an anion gap and MALA diagnosis is still uncertain.

Case Presentation: Cases involving six Caucasian patients with suspected MALA who were admitted to the emergency department were analysed. All these patients presented with pH values < 7.35, lactate levels > 2 mmol/L, and estimated glomerular filtration < 30 mL/min. Metformin plasma concentrations were > 2.5 mg/L in all the patients. The highest metformin concentrations were not found in the patients with the highest lactate levels. The anion gap values ranged from 12.3 to 39.3, with only two patients exhibiting values > 14.

Conclusions: In patients with MALA, there is a significant variability in the anion gap values, which is not related to the level of metformin accumulation, and therefore, it is doubtful whether measuring anion gaps is useful as an approach for MALA diagnosis.
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http://dx.doi.org/10.1186/s13256-020-02655-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7818914PMC
January 2021

The importance of organizational variables in treatment time for patients with ST-elevation acute myocardial infarction improve delays in STEMI.

Australas Emerg Care 2021 Jun 14;24(2):141-146. Epub 2020 Nov 14.

University of Barcelona Faculty of Medicine and Health Sciences, Fundamental Care and Medical-Surgical Nursing Department, School of Nursing, Barcelona, Spain; Research Networking Centre of Rare Diseases, CIBER-ER, Unit 747, Spain.

Background: The time between arrival at the emergency department (ED) and balloon (D2B) in STEMI is one of the best indicators of the quality of care. Our aim is to describe treatment times and evaluate the causes of delay.

Methods: This is an observational retrospective study, including all consecutive STEMI code patients ≥18 years old treated in the ED from 2013 to 2016.All the patients were stratified into two groups: delayed group with D2B>70min and non-delayed ≤70. The primary variable was D2B time.

Findings: In total 327 patients were included, stratified according to their D2B as follows: 166 (67·48%) in the delayed group and 80 (32·52%) in the non-delayed group. The delayed group was older (p=0·005), with more females (p=0·060) and more atypical electrocardiogram (ECG) STEMI signs or symptoms (p=0·058) (p=0·087). Predictors of shorter D2B time were: typical STEMI ECG signs and short training sessions for nurses on identifying STEMI patients.

Interpretation: There are delays particularly in specific groups with atypical clinical presentations. Short training sessions aimed at emergency nurses correlate with shorter delay. This suggests that continuing training for emergency nurses, along with organizational strategies, can contribute to increasing the quality of care.

Clinical Trial Number: NCT04333381.
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http://dx.doi.org/10.1016/j.auec.2020.10.001DOI Listing
June 2021

Anticholinergic burden in patients treated for constipation in an emergency department.

Emergencias 2020 09;32(5):349-352

Servicio de Farmacia, Hospital Santa Creu i Sant Pau, Barcelona, España.

Objectives: To evaluate the anticholinergic burden on discharge of patients treated for constipation in an emergency department (ED) and to assess the effect on emergency revisiting within 30 days.

Material And Methods: Observational retrospective cohort study. We collected cases with a discharge diagnosis of constipation after ED treatment between September 2018 and June 2019 and recorded information on all drugs taken and the anticholinergic burden of treatment. A revisit to the ED within 30 days was the primary outcome.

Results: We included 104 patients. A high anticholinergic burden of treatment was identified in 47 (56.6%), an intermediate burden in 30 (36.1%), and a low burden in 6 (7.2%). Twenty-nine (27.9%) patients revisited the ED within 30 days of discharge. An intermediate anticholinergic burden (23 patients [31.1%] vs 4 [13.3%]; P = .061) and high burden (19 [40.4%] vs 8 [14.1%]; P = .002] was associated with revisiting within 30 days in the univariate analysis. On multivariate analysis, a high anticholinergic burden was independently associated with a higher rate of revisiting than a low burden: adjusted odds ratio (aOR), 4.21; 95% CI, 1.07-16.5; P = .039. An intermediate load was not associated with more revisits, however: aOR, 1.27; 95% CI, 0.25-6.41; P = .776. Prescription of long-term treatment with laxatives on discharge did not reduce revisiting withing 30-days in the group with a high anticholinergic load (OR, 0.86; 95% CI, 0.48-3.27; P = .526), but it did have an effect in patients an intermediate burden (OR, 0.13; 95% CI, 0.02-0.99; P = .049).

Conclusion: The prescription of drugs leading to a high anticholinergic burden was a factor associated with ED revisits within 30 days in patients treated for constipation.
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September 2020

Learn, unlearn, and learn again: the secret to changing how elderly patients are attended in the emergency department.

Emergencias 2020 Abr;32(2):122-130

Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España. Proceso de Atención Urgente, Hospital de la Santa Creu i Sant Pau, Barcelona, España.

The demographic shift toward ever greater numbers of older patients with multiple conditions and functional dependency has increased pressure on emergency departments (EDs). The traditional approach to emergency treatment does not resolve problems in this population, creates risk, leads to high admission rates, and collapses the ED itself. Medical associations recommend that multidisciplinary teams incorporate geriatric assessment strategies and procure safe care enviroments. Implementing such recommendations will require profound changes in ED processes and staff and in connections between the ED and the community the patient is discharged to. This paper describes the processes we used in our tertiary-care hospital to achieve the necessary level of change. Our aims were to ensure that the ED staff provides correct diagnoses and treatments for elderly patients; bases decisions on the patients’ clinical, social and functional needs and the preferences of both patient and family; and arranges for the most appropriate treatment environment in each case. All these changes were essential for properly addressing new care demands while achieving optimal patient outcomes and contributing to better ED and hospital performance.
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March 2020

Older patients with non-ST-segment elevation myocardial infarction in the emergency department: What approach is best?

Emergencias 2019 06;31(3):151-153

Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España.

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June 2019

Development of a comprehensive, multidisciplinary program of care for frailty in an emergency department.

Eur Geriatr Med 2019 Feb 11;10(1):37-46. Epub 2018 Dec 11.

Emergency Department, Hospital de la Santa Creu I Sant Pau, c/Sant Quintí 87, 08025, Barcelona, Spain.

Purpose: Frailty and multi-morbidity have been associated with increased pressure on Emergency Departments (ED), higher hospital admissions and more risks for patients arising from the ED stay. The advantages of developing specific attention to frailty in ED have been highlighted. The benefits of these approaches are related to patients but also to organizations. The aim is to present how a Program of Care for Frailty (PCF) in an ED impacts on patient flows.

Methods: Setting: A tertiary, teaching, 550-bed urban hospital, with 80,000 adult patients/year ED attendances (43% ≥ 65 years). The three main axes of the program are (1) an ED geriatrization, implementing multidisciplinary comprehensive geriatric assessment performed by ED professionals (physician, nurses, social worker, pharmacist); (2) an elder-friendly area (EFA) inside the ED was built; (3) The ED integration in a collaborative network with others healthcare providers in the territory for a shared urgent care.

Results: Between 2011 and 2017, we observe a progressive increase in ED activity (+ 8.1%), in patient's age (40.9% vs 42.8% ≥ 65 years), and an increase in ambulance arrivals (+ 25.1%). The admission rate was rising until 2014 (10.8-12%). In 2014, the ED geriatrization began and networking was reinforced, and a decrease in the rate of admission (11.3%) is observed.

Conclusions: Despite a progressive increase in ED activity and older people, we have observed a decrease in hospital admissions in parallel with the Program of Care for Frailty development. Systematic application of similar programs in distinct EDs would have an impact on the overall health system.
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http://dx.doi.org/10.1007/s41999-018-0151-2DOI Listing
February 2019

Opportunity for emergency medicine and geriatric-orthopedic specialists to improve the emergency department care of elderly patients.

Emergencias 2019 02;31(1):70-71

Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona. IIB Sant Pau, Barcelona, España.

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February 2019

Diagnosis of pulmonary embolism in the elderly: adherence to guidelines and age-adjusted D-dimer concentration values.

Emergencias 2018 10;30(5):321-327

Servicio de Urgencias, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, IIB Sant Pau, España.

Objectives: . The main purpose was to assess our emergency department's level of adherence to clinical practice guidelines (CPGs) for the diagnosis of pulmonary embolism in different age groups. The secondary aims were to study the utility and estimated the number of avoidable CT angiography with this approach of age-adjusted D-dimer concentrations in combination with the Wells score in the diagnosis of pulmonary embolism.

Material And Methods: Retrospective observational study of a series of hemodynamically stable patients suspected of having pulmonary embolism in the emergency department of a tertiary care university hospital in 2012. Cases were identified in hospital discharge records on the basis of orders for D-dimer assays and computed tomography (CT) angiography of pulmonary arteries justified by suspicion of pulmonary embolism. We analyzed the degree of adherence to CPGs according to age groups, calculated the specificity and sensitivity of combining age-adjusted D-dimer test results and the Wells score, and estimated the number of potentially avoidable CT angiography procedures.

Results: We found a total of 785 patients (mean age, 69 years; range, 18-97 years) suspected of having pulmonary embolism; 403 (51.3%) were women. Significant differences were detected in adherence to CPGs, depending on which clinical prediction models were used and patient age (50 years or younger, 69.7%-76.5% adherence; 65-74 years, 32.3%-53.2%; 75-84 years, 29.1%-46.8%; 85-89 years, 32.7%-41.8%; and 90 years or older, 24.4%-46.7%). Adherence was increased when D-dimer test result and the simplified Wells score were combined (increments of 10.4%, 8.0%, 13.6%, 11.1%, respectively in the following age groups: 65-74 years, 75-84 years, 85-89 years, and 90 years or older). Using an ageadjusted D-dimer cut-point increased diagnostic specificity (34.2% without such a cut-point vs 45.8% with one). The positive predictive value of the test also increased when an age-adjusted D-dimer cut-point was used (to 11.4%, from 9.6% without age adjustement). Seventy CT angiograph procedures (12.5%) could have been avoided by using age-adjusted cut-points.

Conclusion: We observed different degrees of age-related adherence to CPGs in cases in which pulmonary embolism was suspected. Using the simplified Wells score combined with an age-adjusted cut-point for D-dimer assay positivity improved the specificity and positive predictive value of the D-dimer assessment in comparison with standard practice. Using age-adjusted D-dimer cut-points could decrease the number of pulmonary artery CT angiograms required.
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October 2018

What to do if the patient with acute hyperglycemia is not to be admitted to hospital? A call for new protocols according to the emergency department stay.

Emergencias 2018 Ago;30(4):280-281

Servicio de Urgencia y Coordinación de Trasplante. IIB Sant Pau. Universitat Autònoma de Barcelona, Hospital Sant Pau, Barcelona, España.

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July 2019

[European curriculum for emergency medicine and geriatric emergencies: another step forward for emergency department geriatric care].

Emergencias 2017 07;29(4):290

Servicio de Urgencias y Coordinación de Trasplante, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España.

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July 2017

[Emergency department staff, the limitation of life-sustaining treatment, and the feasibility of organ donation].

Emergencias 2016 Dic;28(6):425-426

Servicio de Urgencias y Coordinación de Trasplante, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, España.

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November 2017

[New Tools for coping with hospital emergency department overcrowding: managing throughput, decisionmaking, and operational flexibility].

Emergencias 2015 Dic;27(6):424-425

Servicio de Urgencias y Coordinación de Trasplante, Hospital de la Santa Creu i Sant Pau, Barcelona, España.

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November 2017

[Prevalence of arterial hypertension and lipid profile in HIV patients].

Med Clin (Barc) 2008 Nov;131(18):681-4

Servicio de Medicina Interna. Hospital de la Santa Creu i Sant Pau. Barcelona. España.

Background And Objective: It is not known whether human immunodeficiency virus (HIV)-infected patients present, compared to non-HIV controls, higher vascular risk factors. Our objective was to analyze whether there are differences in blood pressure in HIV patients compared to non-HIV controls.

Patients And Method: We retrospectively analyzed all HIV patients controlled in our centre, who were compared with a control group of blood donors, matched for age and sex, blood pressure and lipid profile. We evaluated the following variables: demographic data, date of HIV diagnosis, presence of lipodystrophy, antiretroviral treatment, duration of this treatment, and vascular risk factors.

Results: We evaluated 740 patients (mean age: 41.8 years; 75% men). We detected a higher prevalence of hypertension in the HIV group (25% vs. 15%) with a significant difference in the mean systolic/diastolic blood pressure between both groups (p < 0.0001). In the HIV group, hypertensives were older than normotensives, and had higher prevalence of lipodystrophy and higher total cholesterol with a shorter disease duration (75 vs 85 months). In the total group of hypertensives, HIV patients were younger than non-HIV (44.2 vs 47.9 years; p < 0.009) and had higher total cholesterol values (5.44 vs 5.18 mmol/l; p < 0.052).

Conclusions: We found a higher prevalence of hypertension in HIV patients compared with matched controls, as well as a higher prevalence of lipodystrophy and vascular risk factors in hypertensive HIV patients compared with non-hypertensive.
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http://dx.doi.org/10.1157/13129111DOI Listing
November 2008